Bacteriologically confirmed pulmonary tuberculosis patients: Loss to follow-up, death and delay before treatment initiation in Bulawayo, Zimbabwe from 2012–2016

Abstract Objective To quantify and assess trends and risk factors for loss to follow-up (LTFU) and delays before treatment initiation among bacteriologically confirmed pulmonary tuberculosis (TB) patients (laboratory-diagnosed) in Bulawayo, 2012–16. Design Cohort study using secondary programme data. Presumptive TB patients’ sputum samples were sent to the laboratory from the 19 primary health care clinics. Laboratory-diagnosed patients (microscopy or Xpert MTB/RIF) were tracked for treatment registration at the clinics. Results Of 2443 laboratory-diagnosed patients, the mean (standard deviation, SD) delay from sputum receipt at the laboratory to testing was 2.7(1.6) days and from testing to result dispatch was 8.8(5.8) days. A total of 508(20.8%) were LTFU which included 252(10.3%) deaths. While the number of laboratory-diagnosed patients reduced over years, there was a significant increase in pre-treatment LTFU and death. Independent predictors of pre-treatment LTFU were age above 65 years, male gender and HIV positive/unknown. In addition, delay (≥3 days) between sputum receipt and testing was significantly associated with pre-treatment death. Among registered patients (n = 1935), the mean (SD) delay to initiate treatment was 29.1 (21.6) days which significantly declined over the years. Patients registered as new TB had significantly long treatment delay. Conclusions Interventions to mitigate the risk factors for high loss to follow-up, deaths and delays before TB treatment are urgently required.